Attitudes Towards Suicide Pre- and Post- QPR Training

Authors: Shayla Crandell and Jamie Eastwood, Helena College University of Montana


Objective: This study measures individual attitudes based on pre and post suicide prevention training between those trained and not trained in Question, Persuade and Refer (QPR) to see if individual attitudes could be changed by this particular prevention program. Methods: We compared 60 student’s individual attitudes between two classes. One class being trained in QPR and the other receiving no training in QPR, using an Attitude Toward Suicide Inventory. Results: We found that there was no significant positive attitude change with individuals trained and not trained in QPR. Conversely we found that there was an increased negative attitude in the individuals in the experimental group who were trained in QPR compared to those in a control group not receiving training. Conclusion: This study would benefit from a larger sample size as well as looking into not only attitudes toward suicide but individual’s actual behaviors. Further research will need to be conducted to insure that those receiving training understand the basis of the QPR.

Introduction to the Study

Suicide can be one of the most preventable cause of death, yet preventing it has been a huge struggle. According to the Center for Disease Control and Prevention (2014) suicide is the second leading cause of death in individuals between the ages of ten and thirty-four years; fourth leading cause of death in 35 to 54 years-of-age and 10th overall in the United States. Montana is ranked number one in the nation for number of suicide as of 2014 according to the American Foundation for Suicide Prevention (AFSP). Many prevention programs have focused on preparing individuals who may come in contact with suicidal individuals to respond in a way that encourages help seeking behavior. If these programs are successful they must achieve three things; (1) change the prevailing attitudes about suicides, (2) provide tools that a person can use to effectively intervene, and (3) motivate individuals to take action. The current research focuses on attitude change by investigating whether a popular suicide prevention program, Question, Persuade and Refer (QPR) can change individual’s attitudes. QRR is designed to teach people the appropriate signs and symptoms of other individuals that may be or become suicidal and get them to the proper place for care. A person trained in QPR they will learn to recognize the warning signs of suicide; know how to offer hope; and know how to get help and save lives (qprinstitute, 2013). QPR outlines statistics on a state to state and national basis, as well as provide the correct ways to approach and ask the appropriate questions in a crisis situation (qprinstitute, 2013), as well as, defines both myths and facts about those individuals who may be in crisis. There are several theories of attitude change which promote behavioral change (Zimbardo & Leippe, 1991), however, most of these models agree that individual attitudes are persuaded via two potential routes: (1) the peripheral route, and (2) the central route (Zimbardo, & Leippe, 1991; Petri, & Govern, 2004). The peripheral route results in short-term attitude change and includes change in attitudes due to the persuaders appearance, perceived expertise, and how attractively the argument is presented (Fiske, 2010; Leary, 2010). This type of attitude persuasion tends to work, but only for a short amount of time. In order to create long-term attitude change one must engage in central route processing (Fiske, 2010). Central route processing is when one deeply and cognitive evaluates information, makes a meaningful interpretation of information, and makes a social commitment to change (Ross, & Nisbett, 2011). However, in order for one to engage in central route processing, research has found that there must be five elements present which include:

  1. The information must be made personally relevant.
  2. The person has to be able to cognitively understand and interpret the information.
  3. The person must be made to feel like he or she has the abilities and tools to engage in a given behavior.
  4. The person must be able to practice or visualize him or herself engaging in the behavior.
  5. The person must be able to engage in the behavior within novel and unexpected contexts (Fiske, 2010; Ross & Nisbett, 2011).

The question for this paper is whether or not QPR promotes central route processing to engage in more long-term attitude change? The research hypothesis there for is; QPR will influence a positive direction.

Ho: There will be no difference between groups from pre to post measurement.

H1The experimental group will have a significantly better attitude on post measure compared to control group.

Research Method

The sample for this study was comprised of 60 students enrolled in a local college who were attending Abnormal Psychology and a College Writing course. The final sample consisted of 38 females and 22 males. The mean age for all students was 26.37 (SD= 8.68); 18 of female and 11 male students (n=29) were surveyed in a course in which QPR training was provided (experimental group), and 20 females and 11 male students were surveyed in a course where QPR was not provided (control group) (n=31). This study was reviewed and approved by the University of Montana Institutional Review Board.

Measure. Attitude Toward Suicide Inventory (Knight, Furnham, & Lester, 2000) was measured with a questionnaire developed for use in this field. This survey contains 33 statements from the Attitude Toward Suicide Inventory. Questions were on a likert scale disagreement: (1) completely disagree, (2) do not agree, (3) undecided, and agreement: (4) agree, (5) completely agree. These were later broke down into five factors based on specific attitude categories that will be delineated in the results section. In this research for reliability the Cronbach’s alpha was .70, which is moderate and acceptable for reliability.

Procedures. Each group took five minutes before the start of class to complete the questionnaire. In the experimental group, after completing the pre-attitude questionnaire, were then trained in class for QPR. The control group, after their questionnaire, then sat through their regular scheduled lecture. After each class, both groups were given five minutes to complete a post- attitude questionnaire. A total of four classes were sampled, two in fall semester of 2015 and two in the spring semester of 2016. Initial analysis indicated no significant difference due to the time during which the research took place.


After data had been cleaned for missing data points and outliers, a confirmatory factor analysis was conducted, consistent with work by (Knight, Furnham, & Lester, 2000) five factors emerged. Two factors were selected for the significant of this research. Factor 1, which measured ambivalence, and factor 5, which measured attitude of shame. After selecting these two variable analysis was conducted to assure normal distribution of data and sphericity of data to make sure repeated ANOVA analysis was appropriate for this data. Table 1 and 2 provide the means and standard deviations for both attitudes measured.

Screen Shot 2016-04-18 at 11.37.56 AM

Screen Shot 2016-04-18 at 11.38.07 AM


The first attitude measured was ambivalent, which consisted of questions such as “I would feel ashamed if a member of my family committed suicide” and “people who commit suicide are usually mentally ill.” As figure 1 indicates for the experimental group ambivalence increased; however, in the control group ambivalence decreased. According to a repeated measures ANOVA the model was non-significant (F (1,45) = .094, p = .761), and there were no group differences (F (1,45) = .095, p =.760). However, as Figure 1 indicates there was a significant interaction (F (1,45) = 1382.62, p < .001) this can be contributed to sample size, as a power analysis indicated a sample of 186 participants would be necessary to reach significant effect.  

Screen Shot 2016-04-18 at 11.37.35 AM


The second variable of interest was shame (factor 5), example questions included “people do not have the right to take their own lives” and “Those who commit suicide are cowards who cannot face life’s challenges.” As Figure 2 indicates in the experimental group shame increased, while in the control group shame remained roughly the same. According to a repeated measures ANOVA the overall model approach significance (F(1,45) = 2.857, p < .10), and there was a significant interaction (F(9,45) = 3.941, p = .05).

Screen Shot 2016-04-18 at 11.37.44 AM

Discussion, Conclusions, and Recommendations

Based on the hypothesis of this study, the findings do not support that QPR training positively changes attitudes toward suicide, but based on the interactions may create a more negative attitude in comparison to a control group. However, because there was no main effect the interaction must be qualified and cautioned. These findings could be influenced by a number of different factors such as, presenter, lack of engagement between training, the inability to randomly assign individuals to the control and experimental conditions, and individual participant variables. As noted, an individual must be able to practice or see him or herself engaging in the behavior (Fiske, 2010; Ross & Nisbett, 2011). The relevance of the information could also play a part in the findings. If a person does not find themselves being able to relate to the information this could create a negative attitude if thinking this situation will not happen to them. As mentioned: an individual must be able to make information personally relevant (Fiske, 2010; Ross & Nisbett, 2011, p.?). Sample size could also be cause for these findings. A sample of 186 participants would be beneficial in a further study looking into QPR training and attitude change toward suicide, the sample size maybe the culprit in not achieving a main effect. Furthermore, a further study should focus not only understanding attitude change but also actual behavior of individuals.


American Foundation for Suicide Prevention. Suicide Statistics. (2014). Retrieved October 28, 2015, from

Center for Disease Control and Prevention. National Suicide Statistics. (2016, August 28). Retrieved October 28, 2015, from

Fiske, S.T. (2010). Social Beings: Core Motives in Social Psychology. Danver, MA: John Wiley & Sons, Inc.

Knite, Matthew T.D., Furnham, Adrian F., & Lester David. (2000). Lay Theories of Suicide. Personality and Individual Differences, Vol 29(3), 453-457.

Leary, M.R. (2010). Affiliation, acceptance, and belonging: The pursuit of interpersonal connection. In Fiske, S.T., Gilbert, D.T., & Lindzey, G. (Eds) Handbook of Social Psychology (5th ed). Danver, MA: John Wiley & Sons, Inc.

Petri, H.L. & Govern, J.M. (2004). Motivation: Theory, Research, and Application (5th ed). Belmont CA: Wadsworth Publishing

QPR Institute | Practical and Proven Suicide Prevention Training (2013). Retrieved April 01, 2016, from

Ross, L., & Nisbett, R.E. (2011). The Person and the Situation: Perspectives on Social Psychology. New York, NY: McGraw Hill, Inc.

Zimbardo, P.G., & Leippe, M. (1991). The Psychology of Attitude Change and Social Influence. New York, NY: McGraw-Hill, Inc.

END NOTES: This paper was originally presented at the Fourth Annual Montana Student Research Forum for Two Year Colleges on April 8, 2016. Research was conducted at Helena College University of Montana with Institutional Review Board approval through the University of Montana. Supervising faculty for this paper were Professor Curtis Peterson, Professor Karen Henderson, and Dr. Nathan Munn.


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Social Psychologist

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